Healthcare Provider Details

I. General information

NPI: 1477486322
Provider Name (Legal Business Name): HALO REENTRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 N ACADEMY BLVD STE 210
COLORADO SPRINGS CO
80909-1568
US

IV. Provider business mailing address

1465 PETERSON RD
COLORADO SPRINGS CO
80915-3138
US

V. Phone/Fax

Practice location:
  • Phone: 719-644-4387
  • Fax:
Mailing address:
  • Phone: 719-644-4387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JEREMY J PAVLIK
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 719-644-4387